Tuesday 3:58 pm ~ The Moment Before Play
Posted: March 14, 2013 Filed under: child therapy, Play Therapy | Tags: child psychology, Play therapy 1 Comment »
Away papers, away email, away almighty phone.
HE IS HERE, all peals and squeals, with a cheek-breaking smile,
awash in giggles deep and rippling,
body bursting with the joy of movement.
Farewell, logic; I have no need of you this hour.
Agenda, hold your horses; I may use or abandon you.
Patience, hover near and help me.
Child, take my hand, take my brain.
Make me soft enough to trust, real enough to tell.
- Beth Onufrak
The photo above was taken in my office playroom on a sunny Phoenix winter afternoon.
The child’s white board drawing of a flower and heart is labeled, “You can bloom.”
“You’re Taking Your Child to a Shrink?”
Posted: February 9, 2013 Filed under: Behavior, child therapy, Development, Discipline, Finding a provider, Meltdowns, Parenting, Therapy, Uncategorized | Tags: child psychology, clinical child psychology, developmental, therapy Leave a comment »You’ve wondered and waited ~ with your worries and wishes. You’ve hoped this was “just a phase” in your young child’s life. Time after time, you’ve reassured yourself, “He’ll outgrow this; he’s young” or “she has so much time.” In talks with your partner, you’ve raised your concerns … and talked yourself out of them as the weeks and months (or years) passed. There have been periods when he blossomed and was doing just fine. Times when those problems seemed far behind her.
Then the difficult days return … An event occurs, a moment arrives when it’s all too clear – you cannot manage this yourself. You are out of ideas. You begin to ask around, look online, make some calls. Make an appointment with dread and hope, shaky nerves and eager heart. Nearly every parent who seeks child treatment describes these phases. Now that you’ve made that call, you wonder what (or whether) to tell family & friends. The reactions of others can be a gnawing concern:
“I’m not even mentioning this to my mother, she’d have a cow.”
“I can just hear my dad now … ‘MY grandson is not crazy!’ ”
“We’re not telling our friends, they wouldn’t get it – she’s an angel at other people’s houses.”
You are not alone if this story sounds like yours. In fact, you are entirely typical. You may feel wary of following your plan while anticipating disapproval from others. It is hard to seek outside help. So hard that many families put it off a little longer. A good number of parents arrive moist-eyed and shake my hand confessing, “We should have been here two years ago. We knew things were getting bad, but we just weren’t ready.”
How do you know when it’s time? The following benchmarks may tell you: When you have tried countless strategies, but the problem keeps worsening; when you’re starting to worry about the safety of your child and those she plays with; when the problem is hampering friendships, school, and family life; when your child doesn’t seem to enjoy “being a child;” when there are more “bad” days than good and his or her self-esteem appears to be suffering.
How do you select a child mental health provider? At local community mental health centers, staff assign a therapist to match your needs. If you select a health insurance provider or elect to private pay, your choice will be more personalized.
- Ask trusted people. You’d be surprised how many parents have struggled behind the scenes just like you. Many have a favorite provider they count upon.
- Look online. More and more providers have websites and social media presence. How do they describe their practices? Check out their Facebook business page posts. What do they Tweet? How do you like their material?
- Call for an initial inquiry. Do you feel comfortable interacting with the office staff?
- Understand medication vs. therapy. Medication is prescribed by psychiatrists, physicians & nurse practitioners. Therapy is provided by psychologists, counselors, & social workers
- Ask if a parent-only intake is possible. Not all providers can offer this. However, such an intake allows coverage of sensitive topics you don’t wish to discuss in front of your child.
O.K., so you’ve made an appointment. Or you’ve begun the process and feel ready to tell people.What do you say? I offer these suggestions:
We’ve found a provider who specializes in young children.
We need “new ideas” to address a big problem that just isn’t going away.
We want to help our child now before the problem grows so we can have “better days” together.
After meeting your therapist, assess how you feel. Provider-family “fit” is very important! But a degree of unease is natural until you all settle in. Be open to sharing information. Providers cannot truly help your child or family without the “full picture.” Know that any personal information you share is entirely in service of your child. Also, be ready to change yourself! Providers help young children by giving their grown-ups “new ideas.”
Seeking help for your young child is a step of courage. And it can make a world of difference! Intervention with young children sweeps stones off the path of development before they become boulders. Begin early so the only thing weighing upon his young shoulders is sunshine. 
“You can tell me anything, I’m a puppet!” Why Play Therapy Works
Posted: September 24, 2012 Filed under: anger management, Behavior, child therapy, Cognitive, Emotional self-regulation, Impulse control, puppets, Social Leave a comment »Criss-cross applesauce, a spunky boy sits on the whimsical playroom carpet, eyes wide, mouth agape. He’s listening to my impulsive puppet Freddy exclaim, “I get so mad, I want to kick him in the leg!” Freddy elaborates: “Why won’t he just play my game, my way, every time?” It’s no longer any surprise. Nine times out of ten the amazed child replies, with visible relief, “THAT’S JUST HOW I FEEL!”
The child I have in mind speaks to the puppet, and he’s not alone. Freed by genuine understanding and clear acceptance, the child opens his heart. He pours out his own troubles to the boy, girl, dragon, wolf, octopus, skunk, or chipmunk on my hand. “I know, last night I kicked my brother,” he offers, commiserating with the puppet. “I hate time out.” Another child reveals, “I did that in school and got sent to the principal. It was the worst day EVER.”
Now, I have a nice degree on the wall, with all the rights and privileges thereunto appertaining. But puppets are my co-therapists and their credentials seem to surpass mine. Children tell the puppets far more than they tell me alone. Why is this?
The answer is simple: Puppets give safe distance. No child wants to see a therapist who fixates on her problems, nor feel there’s something wrong with herself. In my playroom, it’s the puppet who has the problem. And to a much greater extent than the child. That’s the secret. If a child is here for anxiety, Puppet Miranda has hilarious, unreasonable terrors. The boy here for anger meets puppet Pedro, who mentions unmentionable aggressive thoughts … the very thoughts children harbor and sometimes enact. The boy can hardly believe Pedro feels the same way. And before he knows it, we are talking. Other puppets join us, supportive “voices of reason.” Four-way conversations ensue between the troubled puppet, the helper puppet, the child … and oh yeah, me.
Puppets help bring the child’s problem comfortably into the room. They often speak for the child, making her feel not so alone and not so BAD. Puppets are but one of many play therapy tools. But for me and many child providers, they open the door. Puppets are exceptional delivery vehicles for Cognitive Behavioral Play Therapy, described above. CBPT helps children try on new thoughts and rehearse new behaviors. And guess who models those — yes, the puppets.
There are many models of play therapy, including directive (didactic in style), non-directive (following in style), and familial (incorporating parents). One expressive mode is Sand Tray therapy, using miniature toys children select and arrange in sand. Sand Tray helps children heal from trauma, abuse, and emotional damage too painful to speak aloud. Regardless of the mode, play therapy provides stand-in symbols (toys, materials) to represent feelings and people, events and things, wishes and fears. The child’s imagination creates a buffer and a flexible “space” to explore tough stuff. Therapeutic play allows the freedom to approach and retreat from uncomfortable ideas, memories, and feelings. Children open up about burdens such as obsessions and compulsions, low self esteem, wishes that one was “never born,” despair, rage and shame. Play gets inner feelings “out on the table” so we can deal with them together.
So puppets are one tool of the play therapist. The puppet-child connection is unsurpassed in early childhood psychotherapy. Children often bond with their puppets friends, proudly believing they themselves are the helpers. One child brought a nugget of puppy chow to nurture a chronically anxious puppet. “Worry Wolf,” she entreated, “you have GOT to get hold of yourself!” She then rattled off an expert list of self-calming tips for emotional regulation. Well-remembered and expertly modeled. Parents bring their children for follow-up visits, amazed with progress. In a hush, they whisper, “He’s been talking about Freddy nonstop for two weeks.”
Good. Freddy sends a tangible and memorable message out the door – long outlasting the single hour with me. I ought to put him on the payroll.
#parenting #playtherapy #puppets #self-regulation #angermanagement #child psychology
To Do or Not To Do
Posted: September 8, 2012 Filed under: Behavior, Discipline, Emotional self-regulation, Impulse control, Parenting 5 Comments »I have a child in mind who is running through the house, tracking mud along the journey, jumping on the couch, scrambling up on a countertop, dropping clothes in the hallway, making tsunamis in the tub.
And into his little ears comes a reprimand (or two or three) passed down through The Ages: “Cut that out, now you behave yourself.” “Stop it.” “Don’t do that!”
These phrases are ingrained in the sub-conscious minds of most adults. They fly out of our mouths like pre-recorded messages. Actually, we do have “recordings” in our minds, for better or worse, from parental words spoken to us. These are often the first words we spout forth, even without thinking – they are part of us.
But STOP & DON’T are the least effective words to change children’s behavior. My job is to look through a child’s eyes, listen through a child’s ears. A child may hear:
“Anthony, stop that right now or there’ll be no XBox when we get home.”
I usually hear the following translation:
“Anthony, cease this action right now, even though you are physically activated and completely engrossed in it. Calm yourself down, generate a list of other things you could do, select an alternative acceptable behavior, and re-route your mental and physical energy into that. Otherwise, you will lose a privilege several hours from now, long after this moment has passed.”
In psycho-babble, we are asking him to deploy his emotional and physical self-regulation skills and use executive functions. OK, let’s switch to plain old English! Only telling him STOP/DON’T asks him to take control of his body and emotions, suppress a strong impulse, and make a measured decision about what to do instead. All of which require his frontal lobes … which are still growing.
Grown-ups can act as a child’s frontal lobes. Tell him what TO DO instead of what NOT to do.* It’s an extra thinking step – in an already busy day — but it yields the best results in the now and promotes learning for next time. It’s teaching. And it’s loving. It keeps YOU calm. Best of all, it’s effective.
Your effort to convert STOP/ DON’T responses into DOs will pay off. The trick: imagine what your child would be doing if she were not doing this behavior.
- If his shoes were not on the couch, his sneaker feet would be on the floor.
- If she were not running through the house, she’d be using her quiet walking feet.
- If he weren’t squeezing the family cat, he’d be using soft hands.
- If she weren’t hitting brother in the car, her hands would be on her own side touching her own things.
- If he weren’t scribbling, he’d be drawing slowly and carefully.
Sometimes the STOP/DON’T moment is urgent – like hurting or breaking. The first reasonable DO conversion might be “please come here by me.” There you can explain what needs to stop and what else your child can do.
“DO commands” do the initial work for you child’s frontal lobe - they tell her what to do instead. In my experience, children are more likely to comply with constructively phrased, friendly but firm DO commands. Begin with “You may” to add an element of courtesy and authority, a respectful and effective combination. Follow with praise for any amount of effort, however small, and generously describe any response going in the right direction. DO commands are teaching moments.
- “You may make small waves under the water; thank you for trying little waves. Ooh, that’s a little one!”
- “Walk slowly and carefully with that cup of juice, please. Excellent trying! You are really watching that cup.”
- “Hug me with gentle arms, please – oh, that feels so good, thank you for being gentle! “
- “You may move over here [point] away from sissy to make your building. Good job starting to move your stuff.”
DO commands readily lead into detailed praise. When you notice spontaneous displays of DO behaviors you’ve been teaching, give a specific praise! Add lots of description. I call this “Positive Noticing,” detecting and commenting upon cooperative DOs that occur even without your prompting. Quite simply, “catch ‘em being good.”
Try some DO commands. They have changed the lives of many families in my care! Make a list on your fridge converting your most frequent STOP/DON’T commands to DOs. The extra thought will pay off as your child advances in self-control and emotional regulation.
* These ideas are drawn from the Parent-Child Interaction Therapy (PCIT) treatment model developed by Sheila Eyberg Ph.D., University of Florida, with whom Dr. Onufrak trained in her doctoral studies.
Developmental Skylines
Posted: August 29, 2012 Filed under: Cognitive, Development, Emotional self-regulation, Fine motor, Gross motor, Social, Speech & Language, toilet training 2 Comments »The child I have in mind today is growing so quickly, on every dimension of development … but each area progresses at it’s own pace.
In the preschool years, abilities unfold with staggering speed! Children move from mouthing their toes to balancing upon them, reaching for heights. Babbled syllables of every language on earth grow into clear speech in the language(s) of home. Reasoning extends past peekaboo games to twenty-piece puzzles.
The rapid rise in child abilities leaves us gasping at every turn. But advance in one area feeds expectation for comparable advance in another. Growth spurts in another child can generate comparisons with one’s own.
Development, however, is like a city skyline. Buildings of varied heights mirror multiple abilities in different stages of progress. Look at a cityscape with a mathematical eye and you can visualize a vertical bar graph. To a child psychologist, those bars are analogous to normative, uneven growth across developmental domains. These areas are Cognitive (reasoning), Emotional, Social, Speech & Language, Toileting, Fine motor, Gross motor, etc. In no child do those developmental areas grow evenly. Just like the varied heights of downtown. And what a boring skyline it would be if the structures were uniform in shape!
Expect variation between developmental domains in your child. Support your young ones where they are. Lags in certain areas might foretell the need for specialized help, but not necessarily so. If you have concerns, track your observations with detailed notes and refer to them every few months. Public school districts offer free developmental screenings. Child psychologists conduct developmental evals. You may consult your child’s teacher or pediatrician, who follow hundreds and thousands of children, if you are worried. But all those professionals will say a uniform ”skyline” is not the developmental norm. And the window of typical development is very wide.
Observe your child’s individual skyline. And know that your attentive support encourages growth in each developmental area.
Big Upsets? The Three C’s of Calming Down
Posted: August 23, 2012 Filed under: child therapy, Emotional self-regulation, Meltdowns, Parenting 2 Comments »I have a child in mind … crying and wailing, stomping and screaming. How can we help young ones calm down? The secret lies with us. Grown-ups’ reactions can determine the course of a meltdown. The ball is largely in our court.
It doesn’t really seem fair … child meltdowns inconvenience the adult agenda, right? Then why must the adult orchestrate the calm-down? Many parents bring children to therapy to acquire emotional “tools.” But equipping the child is only half the work.
Within the child, a meltdown is a cataclysmic force. Like a ”volcano tsunami,” an articulate 2nd-grader explained. (Now that he has such words!) Reasoning goes off-line like the internet in a downpour. Parents say: “There’s no talking to her when she gets like that.” “He gets this glazed look and I can’t reach him.” If parental agitation escalates, the child perceives a Grand Canyon-sized gulf between one’s anguished self and the adult whose help he needs.
In the young years, calming down is a two-player game. Adult frustration can generate auto-responses, such as “Quit acting like a baby,” or “Stop it, you are just fine! But telling a distressed child she’s “fine” is like ordering rain back up into the clouds. Calming down is a complex, full-body skill to be learned. And no one can be embarrassed or disciplined into a learning a new skill.
To assist parents, I created a quick, portable tool: THE THREE C’s for Helping a Child Calm Down. The work of two psychology heroes of mine, Drs. Dan Siegel and Becky Bailey (see below), inspires this approach.
- CONNECT with your child through empathy. Stand in her shoes. Describe your compassionate grasp of her feelings (“Oh, this is so hard for you / You really wanted that …”). Don’t know what’s wrong? Say, “Ohh, tell me all about it.” Empathy calms the brain’s limbic system enabling the cortex to problem solve. This is Step One, because nothing positive can happen until your child feels “felt” by you. The Message: “I notice and care about your feelings.”
- COOL DOWN yourself first (count to 10, say a mantra ”we can do this”), then cool down your child. Guide and join him in body-calming strategies – watch his reactions and adjust your moves (hug him, stroke his back, say “Let’s breathe together,” “Let’s shake out our hands …”) The Message: “We can cool you down together - I’m with you.”
- COACH your child in a guiding spirit. Start the ball rolling, point her in the right direction, let her carry the ball across the finish line. Think of yourself as a sports coach instructing others’ children – teaching a skill. The Message: “Together we can get through this moment.” Coaching may look like:
- “You be the picker – this arm first, or that one” [through a sleeve]
- “Let’s give your brain a break for a minute, and think about something happy – like HoneyBear”
- “I wonder if you try that [puzzle] piece over in this area …”
While not a panacea, the Three C’s form a component of my interventions across a wide diversity of child conditions, including ones that bring severe impairment. Try the Three C’s - your child’s meltdowns may have a lot less lava!
Literature of interest: Parenting From the Inside Out – Daniel Siegel & Mary Hartzell / Easy to Love, Difficult to Discipline - Becky Bailey.
#parenting #child #meltdowns
Regressions: Back to a Safer Time
Posted: August 10, 2012 Filed under: Baby talk, Regression, toilet training 3 Comments »
Regressions – what are they all about? A child with clear speech returns to baby talk … a potty-trained child reverts to accidents. Many parents are concerned and frustrated by backward steps. After the triumph (and convenience!) of growth forward, regressions can perplex and annoy adults.
Behavioral regressions are temporary steps backward to a safer time, to take a break from uncomfortable challenge. It is a coping strategy. Coping is anything one does to try to manage an uncomfortable state. Development is tough work!
We adults can no longer remember growing on so many developmental dimensions at once. An adult-world analogy might be: starting a new job (cognitive), resuming exercise (gross motor), learning a foreign language (language), taking piano lessons (fine motor), and mastering a new cell phone (emotional – haha!) all at once. You too might fall back on an easier skills while your muscles were sore and your brain tired. You might even throw down your complicated new phone and cry!
Grown-ups may call-out regressive behavior: “Why are you talking like that? You’re a big boy now,” or “Why are we having accidents? You’re not a baby anymore.” The assumption is that a teaspoon of embarrassment might jog the child back into age-appropriate behavior. But such responses miss the child message – which is, “I’m anxious, I’m overwhelmed right now, this growing up thing is hard.” When a child sends a message that is missed, the response is often anger – either internalized (as resentment) or demonstrated (acting out). Shame never feels good. What to do instead?
1) Notice the regression and ask yourself, why might this be happening at this moment? Coping with younger sibling in his life? Working hard on one developmental task (toilet training) may temporarily leave less energy for work on other tasks (puzzles. language, emotional regulation).
2) Check in with your child. “Jordan, I notice you are using your younger boy talk lately. I wonder if something is bothering you today.” Few young children can answer How, Why & What questions. So offer your guesses in “wondering” statements like, “I wonder how you are feeling about baby sister these days.” Offer support and understanding statements. “Yes, I’ve had to hold sissy a lot after dinner.” Your child may offer, “Yeah, and Daddy doesn’t tuck me in like you do!”
When your child shows a regression, take the cue – something is taxing her capacities. Child growth does not emerge in linear lines. Knowing this allows us grownups to accept and observe regressions, interpreting them with gentle acceptance and support.
